Evidence indicates that up to 13.5% of mothers experience depression during pregnancy and postpartum. Research on depressed mothers has documented the devastating impact of depression on maternal functioning and child social, emotional, and cognitive development. Yet, the majority of depressed mothers do not receive effective treatment. In particular, mothers exhibiting multiple risk characteristics (single, poor) face formidable barriers to obtaining treatment. There is a growing population of at-risk mothers and young children participating in early preventive home visitation. This group is especially vulnerable to depression, as evidenced by recent findings that 45% of mothers in home visitation experience elevated depression in the first year of services (Ammerman et al., 2003). Moreover, 88% of depressed mothers in home visitation did not receive treatment despite participation in home visitation. We propose to develop and test In-Home Cognitive Behavioral Therapy (IH-CBT), an innovative 15 session treatment for depressed mothers in home visitation. IH-CBT is specifically designed to be closely integrated with home visitation, thereby optimizing benefits for both interventions. We will conduct a small-scale clinical trial to obtain effect sizes for use in planning a subsequent larger scale R01. Specifically, 100 depressed mothers will be randomly assigned to IH-CBT or home visitation "as usual" (HVAU). Measures of depression, psychiatric comorbidity, adaptive functioning, social support, trauma, and child functioning will be collected at pre-treatment, post-treatment, and 3 month follow up. It is hypothesized that IH-CBT will be superior to HVAU in (1) reducing depressive symptoms, (2) recovery from depression, (3) and increasing social support and social network. We will further examine the potential moderating influences of comorbid psychiatric conditions, and the relationship between depression and trauma and violence. We believe that IH-CBT holds considerable promise for effectively treating a sizable population of depressed mothers who otherwise do not receive appropriate mental health services. Findings from this study will be highly relevant to public health because IH-CBT (1) has the potential to ameliorate depression in mothers participating in home visitation programs, (2) overcomes significant barriers to obtaining treatment by delivering therapy in the home, (3) will be manualized to facilitate rapid adoption by and dissemination in the field. [unreadable] [unreadable] [unreadable]